Month: October 2017

I am not a morning person. Everyone who knows me can attest that I am a true Night Owl and that early mornings don’t work for me. However, the world of Obstetrics functions 24/7, and we start our days early. Like most people, I need my morning coffee to get my day started, and a second- or third!- cup is not uncommon during a hectic day. We have become the Coffee Generation: we start and end our days with it, and we consume it regularly throughout the day. In fact, there is a whole “coffee culture” in our society that emphasizes how perfectly the well-placed coffee house with its myriad of stimulant-laden beverages is needed in our lives.

Limit Your Intake

However, when a woman becomes pregnant one of the first things we teach her is to limit her caffeine intake. For some women, this is the hardest adjustment to make for the duration of their pregnancy. I recommend limiting caffeine to 200 mg/day for a reason: the data about caffeine is inconclusive but the evidence that does exist suggests that it leads to birth defects, premature labor, or preterm delivery when used in excess of 200 mg/day. Caffeine is a stimulant that can lead to undesirable increases in a pregnant woman’s blood pressure or heart rate. Further, caffeine is a diuretic which leads to increased urination (and women are already spending a majority of their time in the bathroom while pregnant!) that can contribute to dehydration; dehydration makes the uterus irritable and causes premature uterine contractions.

Further, caffeine crosses the placenta, stimulates the baby and leads to sleep cycle disturbances, especially in the later stages of pregnancy, that carry over into infancy. Babies can’t metabolize caffeine so the stimulant effects last longer. Therefore, I recommend that women consume no more than 200mg of caffeine daily, which is the equivalent of a 10-12 oz. cup of regularly brewed coffee per day. The problem is that caffeine is in more than just coffee. Tea, chocolate, soda, and even some over-the-counter medications contain significant amounts of caffeine that can have the same effect on both mother and baby as a cup of coffee.

There are many women who, like me, need the “Morning Jolt” to get their day going. Moreover, there are many women who do shift work, multi-task, or work long hours. Caffeine, then, becomes a necessary evil. However, there are some alternatives a woman can reach for to fend off fatigue and get a recharge. One of the simplest and easiest alternatives I teach women is to grab for cold water. Dehydration is the biggest energy-drainer. Pregnant women tend to not consume enough liquids, especially water, and mild stages of dehydration can cause tiredness and irritability. A full glass of cold water may do the trick to ward off the nagging feeling of tiredness, especially during the day. Similarly, hunger can make pregnant women feel run down or have no energy. A high protein or fiber snack may satisfy hunger and provide a needed boost of energy. Sodas and sugary drinks should be avoided; they contain about 20-22mg of caffeine but typically loads of useless sugars, food colorings, and flavorings.

If a simple fix won’t do, I teach women to reach for beverages that have flavor but less caffeine. Green tea, for example, is loaded with healthy antioxidants and only 40 mg of caffeine compared to the 400mg of caffeine found in a 10 ounce cup of brewed coffee from one of the major retail coffee houses. Chocolate milk makes a healthier alternative to a cup of coffee, especially if its homemade.

Homemade Chocolate Milk

A simple recipe is: one cup of low fat milk that is mixed with a teaspoon unsweetened cocoa powder and stirred.

Additional teaspoons of cocoa powder, and dashes of sugar or natural sweeteners like agave, can be added to adjust taste. The milk provides protein and other nutrients while the cocoa provides flavor and only about 8 mg of caffeine.

Listen to Your Body / Baby

Caffeine does not have to be cut out totally but needs to be consumed carefully while pregnant. A pregnant woman should see how her baby is reacting after she finishes her caffeinated drink: if the baby is more vigorous or active immediately after, the caffeine may be too much. Decaffeinated drinks may satisfy the craving for a specific beverage but often those drinks have a different taste that just isn’t the same as the real thing. I’m interested to hear what other women do to satisfy their caffeine cravings? What is your go-to drink or snack when you need a pick-me-up?

The Fall is the perfect time to put the abundance of squash to good use! As the summer unwinds things like zucchini and carrots are at their best, but once the leaves start to turn and the weather begins to have a bit of chill, the incredible varieties of squash are truly at their best. Squash is one of the most versatile produce items: it’s high in nutrients, easy to make, and delicious. Plus, there are numerous ways to use squash as a meal, a side dish, or a snack. However, one of the best ways to use squash is in soups. Fall soups are delicious, make several servings at once, and store well in the refrigerator or frozen.

The key to getting the best flavor from squash is to prepare it in ways that enhance its flavor such as roasting. Squash stands up to roasting and as it slowly caramelizes in the oven its earthy flavors become more pronounced. Roasted squashes like acorn, spaghetti, or butternut make a great side dish or main course. However, that roasted flavor makes an incredible taste profile for soup. While any squash can be roasted then made into soup, I recommend butternut squash soup because of its great taste, high amount of nutrients, and it’s easy to make. My version of butternut squash soup contains vitamins A, C and E, plus potassium and fiber. Plus, I have a secret ingredient that I learned to add from my time spent in Italy: pumpkin!

Adding in pumpkin gives the soup a creamy texture, a wonderful earthy, seasonal taste and adds even more fiber, vitamins, and minerals. Using homemade broth elevates this soup to an elegant meal. This soup is ideal to make in advance and give to a pregnant woman to keep on hand. The recipe can be doubled so it can be frozen in individual containers and thawed for a quick lunch, snack, or dinner. Pair it with toasted whole wheat or sourdough croutons and this will soon become the whole family’s favorite soup.

My recipe is included here along with my suggestions to make an easy chicken or vegetable broth that’s low in sodium and high in taste. Take advantage of the Fall abundance and try this healthy, delicious soup!

Spread squash on a parchment paper-lined baking sheet and roast for 20-25 mins. Remove from oven and allow to cool

In a large stock pot or Dutch oven, sautee onions in 1-2 tablespoons of oil. Cook until onions are translucent, about 5-8 minutes

Using a slotted spoon, add in the roasted chunks of butternut squash. Add in the can of pumpkin puree

Add in the broth and stir to combine

Heat until the soup is bubbling. Turn the heat to low and continue cooking until squash in tender and the soup thickens, about 15 to 20 minutes.

Puree the soup with an immersion blender, a blender, or a food processor. Note: If using a blender or food processor, pulse in batches and pour into another bowl. Once all the soup has been blended or processed, return to the pot and heat through.

Making your own broth

Chicken Broth

4 stalks of celery, cut into large pieces (its OK to leave the leaves attached)

4 cloves of garlic, peeled

Sprigs of thyme and parsley, bundled

4 quarts of water

Combine all ingredients in a large stock pot.

Bring ingredients to a boil over high heat. Turn heat down and simmer for 2 hours.

Strain the broth and discard all the meat, vegetables and herbs. Do not add salt.

Allow broth to cool. Skim off any fat on the surface. Freeze in individual containers or refrigerate up to 1 week.

Vegetable Broth

(this recipe does not contain or use strong acid flavors)

4 stalks of celery, cut into large pieces (its OK to leave the leaves attached)

4 carrots, peeled and cut into large piece

2 parsnips, peeled and cut into large pieces

2 sweet potatoes, peeled and cut into large chunks or quarters

4 cloves of garlic, peeled

3 onions, cut into quarters

4-6 cups of water

Combine all ingredients in a large stock pot

Bring to a boil over high heat.

Reduce heat to medium and simmer for about 30- 45 minutes or until vegetables are all softened.

Strain broth and allow to cool.

Store in individual containers and freeze. Or, refrigerate for up to one week

Tip: Both chicken and vegetable broth can be made in a slow cooker or crock pot. Combine all the ingredients in the crock pot or slow cooker and cook on High for 3 hours or Low for 5 hours. Strain broth and store up to one week in the refrigerator or freeze.

I teach women to eat smaller meals throughout the day and to keep snacks on hand to support a stable blood sugar, fight off fatigue, avoid hunger and maintain adequate fluid intake. In the past, I found myself telling a woman, “Eat a protein snack,” but I never backed it up with examples of what I meant. Everyone’s definition of protein is different (I once had a woman who ate several pieces of deep fried chicken because she thought that as long as she chose meat she was OK). Here I want to provide some examples of easy snacks that will satisfy hunger while providing sufficient protein and other nutrients.

Dried fruits and nuts

Small handfuls of dried fruits or nuts work well to curb hunger and provide healthy nutrition. However, commercially-packaged dried fruits or nuts may contain sugars, preservatives, or salt that need to be avoided. Learn to read package labels carefully to check on the amount of sugars or salts added to a product. Dried fruit can be made easily by drying slices of fruit on a baking sheet in a regular oven. Raw nuts have less salt than ones that are pre-packaged.

Greek yogurt

Greek yogurt is packed with protein and now certain products have extra protein added to them. I advise women to avoid the flavored kind or ones with fruit added: those are mostly sugar which makes blood sugar levels rise then fall and hunger to return. Plain Greek yogurt, then, is the best option with close to 20 grams of protein in one cup. Some women, however, find it too bitter or dislike the consistency; I recommend adding in fresh berries or a tablespoon-size sprinkle of granola for added texture and taste.

Vegetables with yogurt dip

Greek yogurt also makes a great dipping spread for raw vegetables. I mix dill, lemon juice, parsley or tarragon into Greek yogurt then use it as an herb dip for fresh carrot sticks, celery pieces, or radish slices.

Edamame

I love the taste of edamame and think it makes a satisfying snack on the run. 1 cup of edamame has about 17 grams of protein and sufficient calcium and other minerals. I steam them in their shell and take them on the go, or I shell them in advance and take a small container to eat, one by one, at my desk.

Hard boiled eggs

Eggs are full of vitamins and other nutrients. An egg contains significant amounts of B vitamins and has about 6 grams of protein. Plus, hard boiled eggs travel and store well.

Pumpkin seeds

Unsalted, cooked pumpkin seeds have an inherently salty or earthy taste that satisfies cravings and wards off hunger. ¼ cup makes an ideal snack. Be certain, however, that they do not contain extra or added salt (as if often found in commercially prepared products).

Apple and peanut butter

I love peanut butter and can eat spoonfuls right from the jar. However, popular brands of peanut butter, regardless if it’s smooth, creamy, chunky or “natural”, often contains a lot of sugars and calories for a one tablespoon serving. To get the taste of peanut butter without the excess, I recommend eating an apple cut into several small wedges with a tablespoon maximum of peanut butter. The peanut butter contains about 4 grams of protein and the apple, with its fiber and water content, helps keep you feeling full longer. Plus, the apple provides a natural form of sweetness that pairs well with the salty peanut butter.

Peanut Butter Energy Bites

I just admitted that it’s too tempting to take spoonfuls of peanut butter at a time (or at least I agree that it’s hard to take just one small spoonful and put the jar away!). To fight that urge to keep eating peanut butter, I make peanut butter bites that work well to fight off hunger and satisfy any craving for a salty snack. I’m including a super-easy recipe here:

Peanut Butter Bites

1 cup old fashioned oats (not instant!)

½ cup peanut butter (creamy, crunchy or natural)

1/3 cup of honey *

¼ cup chia seeds (optional but they provide protein, good fat, fiber and lots of other nutrients)

1 teaspoon vanilla (optional for a little more sweetness)

2/3 cup toasted, unsweetened coconut (optional)

Mix all ingredients together in a medium bowl. Refrigerate mixture for 30 to 60 minutes

Take a tablespoon-sized amount of mix and gently roll into a ball. If the mix is not sticking (which may happen depending on the peanut butter you use or the humidity) add a few honey, drops at a time, or a dab of peanut butter until the mix comes together in a ball easily

Store in an air tight container in the refrigerator for up to 2 weeks. These can be kept longer in the freezer

*With honey, I prefer to use natural honey from a bee keeper or an apiary as opposed to commercial honey. For example, I use honey from the Tanis Apiary in Pompton Plains, New Jersey because it has amazing taste and works well with a recipe like this.

Roasted Chick Peas

These make a perfect, crunchy snack because they contain the right amount of flavor, vitamins, nutrients, and fiber. They are easy to make and you can vary the recipe by adding in other flavors. I’m including a basic recipe here:

Roasted Chick Peas

1 can (12 ounces) chickpeas (Garbanzo Beans), drained

2 tablespoons olive oil (extra virgin is best)

Salt & Pepper to taste

Preheat oven to 450 degrees

Blot the chickpeas with a paper towel to dry

Mix chickpeas, olive oil, salt and pepper to taste in a bowl

Spread chickpeas on a baking sheet and bake 30 to 40 minutes until brown and crunchy. Use caution toward the end of baking to avoid burning.

Allow to cool. Store in an air tight container for up to one week.

Other flavors can be added to these- try ¼ to ½ teaspoon of garlic powder, cayenne, cinnamon, cardamom, rosemary, garam masala, coriander and cumin to taste when mixing chickpeas with the olive oil. Or, after baking, sprinkle lightly with parsley and fresh grated parmesan cheese.

Just as flu season begins, the news channels and press have been peppered with items citing that a new link between the flu vaccine and the rate of miscarriage has been uncovered. According to the news, a study had come forth within the scientific community that found a connection between women who had received the annual flu vaccine and an increased likelihood of miscarriage. The news, regardless of what medium it was presented in, was scary. Further, the timing of this news could not have been worse: flu season 2017-18 is just starting. However, the researcher in me wanted to take a deeper dive into this new information and withhold an opinion until I reviewed the data.

After a thorough review, this latest study does not change my opinion, nor that of my fellow expert colleagues in professional organizations: Flu shots are necessary, and safe, for pregnant women to prevent the incidence of flu and the horrible consequences that come with it.

Flu shots are necessary, and safe, for pregnant women to prevent the incidence of flu and the horrible consequences that come with it.

What the News Doesn’t Tell You

The study in question was undertaken by noted researchers in the field of influenza. However, I had several issues with their study. First, the researchers did not set out to explore a link, or relationship, between the flu vaccine and miscarriage; what they proposed, then, was a secondary finding. In this small-scale study, there are a lot of words like “may”, “possibly” or “could” and no definitive language saying that there is a link between miscarriage and the flu vaccine. Further, the women in this study were broken down into subgroups: women who miscarried and women who had not, then broken down into further subgroups by age. Risk, then, was hard to ascertain. The risk for miscarriage, then, existed in each category. In research, we calculate our data to establish a confidence interval, or a mathematical degree of “certainty” so we can say, with confidence, the findings of a study are significant, applicable and highly representative of how the rest of the population would respond. This study, however, had a wide confidence interval, meaning there was plenty of “wiggle” room in the data for it to be both right in some instances and wrong or not applicable in others. Lastly, the researchers propose possible mechanisms that could explain how the flu vaccine could increase the risk of miscarriage, but there’s no evidence to support their suggestions. A biological basis for their observations, then, had not been established.

Recommendations

The data from the study is interesting, but not compelling, at this point, to change practice and advise women against the flu vaccine. On the contrary, I continue to advocate and support flu vaccines for women, especially pregnant women. The flu is a devastating illness that can lead to serious, or severe, illness and even death. Less than a century ago women, and children, died of the flu in large numbers and the virus could sweep through communities or neighborhoods rapidly; it still can. The flu vaccine minimizes the chances of contracting the flu, or lessens the impact of a flu infection if it occurs. The American College of Obstetrics and Gynecology (ACOG), the Centers for Disease Control and Prevention (CDC), and other key professional medical and nursing women’s health organizations, continue to promote, support and advocate for women receiving the flu vaccine, especially in pregnancy.

What You Can Do

Each pregnant woman is unique, however, so speak with your health care practitioner about your individual risk and whether the flu vaccine is, indeed, right for you.